Spinal Disorders — NCLEX Nursing Lesson Anatomy & Physiology · RN Track · Medical-Surgical Body Systems · Musculoskeletal System · Spinal Disorders Condition Lesson · NCLEX-PN / NCLEX-RN

Scoliosis, kyphosis, and contractures—why an S-shaped spine can crowd the lungs, how a back brace only works if it's worn, and why "prevention through movement" beats a permanent deformity.

In this lesson

Lesson Objectives
Why This Matters
Disease Overview
What They Look Like
Pathophysiology
Risk Factors
Signs & Symptoms
Nursing Assessment
Diagnostic Tests
Laboratory Tests
Medications
Nursing Interventions
Complications
Patient Education
Clinical Judgment
Clinical Connections
NCLEX High-Yield
Memory Aids
Case Study
Practice Questions
Key Takeaways
References

Lesson Objectives

Differentiate scoliosis, kyphosis, and contractures by cause, findings, and priority nursing care.
Explain how each alters normal spinal/joint physiology and why the classic findings occur.
Recognize scoliosis screening (Adams forward-bend test, rib hump, uneven shoulders/hips) and the role of the Cobb angle, bracing, and spinal fusion.
Apply the priority nursing care—brace compliance (scoliosis), posture/exercise (kyphosis), and contracture PREVENTION (ROM/positioning/mobility)—and post-op spinal fusion care.
Recognize complications (respiratory/neurovascular compromise) and use the NCSBN Clinical Judgment model.

Why This Matters

Prevalence: scoliosis is common—most often adolescent idiopathic scoliosis (school screenings catch it); kyphosis occurs from posture, Scheuermann's disease, or (in older adults) osteoporosis (dowager's hump); and contractures are a frequent, largely preventable complication of immobility (stroke, prolonged bed rest, casting, neuromuscular disease, burns).

Patient safety: severe spinal curves can compress the lungs and heart (restrictive lung disease, reduced cardiac function); contractures cause permanent loss of function and mobility. After spinal fusion, the nurse must protect the spine and monitor neurovascular and respiratory status.

NCLEX importance: heavily tested on scoliosis screening and bracing/fusion care (log rolling, neurovascular/respiratory checks), kyphosis and osteoporosis, and contracture prevention (ROM, positioning, mobility). Builds on the A&P of the spine/joints and the neurovascular assessment.

Why nurses encounter it constantly: nurses screen for scoliosis, teach brace compliance, provide post-fusion care, and—above all—prevent contractures in immobile patients through positioning and ROM. This is daily pediatric, med-surg, rehab, and long-term-care nursing.

Connecting to prior lessons From A&P, recall that the spine has normal curves and that joints move through range of motion when muscles/tendons stay flexible. From assessment, recall posture/symmetry, ROM, and neurovascular checks. These disorders are abnormal spinal curves (scoliosis = sideways; kyphosis = forward hump) or a joint frozen from immobility (contracture).

Disease Overview

Disorder	Core problem & meaning
Scoliosis	A lateral (sideways) curvature of the spine (S- or C-shaped), often with rotation. Usually idiopathic in adolescents; severe curves crowd the lungs/heart. Measured by the Cobb angle.
Kyphosis	An excessive outward (forward) curvature of the thoracic spine ("hunchback"/dowager's hump). Causes: poor posture, Scheuermann's disease, or osteoporosis (vertebral compression fractures).
Contractures	A permanent shortening/tightening of muscles, tendons, or joint tissue from immobility → a fixed joint deformity and loss of range of motion. Largely preventable.

Analogy — bent poles and a rusted hinge

Picture the spine as a flexible tent pole. In scoliosis, the pole bends sideways into an S—if it bends far enough, it presses on the tent walls (the lungs). In kyphosis, the pole curves forward into a hump (like a bent walking cane). A contracture is different—it's like a door hinge that rusts shut because no one ever opened it; a joint that isn't moved gets stuck in one position permanently. The lesson: keep it moving to keep it working.

What They Look Like

Normal spine · scoliosis · kyphosis · a joint contracture NORMAL Gentle S curves SCOLIOSIS Sideways (S) curve; uneven shoulders/hips, rib hump KYPHOSIS Forward thoracic hump (dowager's hump; osteoporosis) CONTRACTURE fixed, can't straighten Joint frozen from immobility; lost ROM — PREVENT it

Scoliosis = a sideways (S/C) curve with uneven shoulders/hips and a rib hump. Kyphosis = an exaggerated forward thoracic hump. A contracture is a joint permanently stuck (flexed) from lack of movement—the key is prevention.

Pathophysiology

Normal physiology: the spine has gentle front-back curves and is straight side-to-side; joints move freely through range of motion because muscles/tendons stay flexible. ↓ What goes wrong: Scoliosis = the spine develops a lateral curve with rotation (idiopathic, congenital, or neuromuscular). Kyphosis = the thoracic spine over-curves forward (posture, Scheuermann's, or osteoporotic vertebral fractures). Contracture = an immobile joint's soft tissues shorten and stiffen. ↓ How symptoms appear: Scoliosis → uneven shoulders/hips, a rib hump on forward bending, asymmetry, and (if severe) shortness of breath. Kyphosis → a rounded upper back, forward head, height loss, and back pain. Contracture → a fixed, flexed joint that can't fully move and loss of function. ↓ How it progresses: severe scoliosis/kyphosis compress the lungs and heart (restrictive lung disease, cor pulmonale) and cause pain/deformity; untreated contractures become permanent and cause disability and pressure injuries. Early detection, bracing/surgery, and movement/prevention interrupt these paths. NCLEX Clinical Pearl — curves vs. a frozen joint Scoliosis = a SIDEWAYS (lateral) spinal curve (screen with the Adams forward-bend test → rib hump; severity = Cobb angle). Kyphosis = an exaggerated FORWARD thoracic curve (often from osteoporosis in older adults). Contracture = a joint permanently STUCK from immobility—and it's prevented with ROM, positioning, and mobility (once fixed, it's very hard to reverse).

Risk Factors

Non-modifiable	Modifiable	Preventable / reducible
Scoliosis: female, family history, adolescence (growth spurt), neuromuscular disease (CP, muscular dystrophy) Kyphosis: older age, Scheuermann's; genetics	Kyphosis: poor posture, osteoporosis (low calcium/vit D, inactivity) Contractures: immobility, prolonged bed rest, improper positioning, unmanaged spasticity/pain	Scoliosis: early screening + bracing Kyphosis: posture, exercise, treat osteoporosis Contractures: ROM, frequent repositioning, splints, and early mobility (highly preventable)

High-risk populations: adolescent girls (idiopathic scoliosis), children with neuromuscular disorders (scoliosis/contractures), older adults with osteoporosis (kyphosis), and any immobile patient—stroke, spinal cord injury, prolonged bed rest, casting, burns, or advanced neuromuscular disease (contractures). Contractures are the most preventable with good nursing care.

Signs & Symptoms

Category	Findings & WHY they occur
Scoliosis	Uneven shoulder/scapula/hip heights, a lateral spinal curve, a rib hump on forward bending (Adams test), asymmetric waist, and clothes fitting unevenly; back pain and, if severe, dyspnea/fatigue—the curve and rotation distort the trunk and can crowd the lungs.
Kyphosis	Rounded upper back (hump), forward head posture, height loss, back pain, and stiffness; in severe cases, shortness of breath—excessive forward thoracic curvature (often osteoporotic vertebral fractures).
Contractures	Decreased/lost range of motion, a joint fixed in a flexed position, stiffness, and functional impairment; commonly foot drop, flexed elbows/knees/hips—shortened soft tissue from immobility.
Expected findings	Mild curves may be asymptomatic; mild ROM limits early in immobility—monitored and treated.
Emergency/urgent findings	Severe respiratory compromise (dyspnea, hypoxia) from a severe curve; neurologic deficits (numbness, weakness, bowel/bladder changes) suggesting cord/nerve compression; post-fusion neurovascular deficits—act promptly.

Why severe curves threaten breathing A severe scoliotic or kyphotic curve deforms the rib cage and reduces the space the lungs have to expand → restrictive lung disease (low lung volumes, dyspnea) and, over time, strain on the heart (cor pulmonale). That's why the nurse monitors respiratory status in severe curves and after spinal surgery—breathing and oxygenation are a priority.

Nursing Assessment

Subjective: back pain, posture changes, uneven clothing fit, breathing difficulty, functional/ROM limits, immobility/positioning history (contractures), and (adolescents) growth/screening history.

Objective: posture and symmetry (shoulders, scapulae, hips, waist), the Adams forward-bend test (rib hump), spinal curvature, ROM of joints, respiratory status, and neurovascular checks; for immobile patients, assess joint position and early ROM loss.

Priority / focused finding	Why it matters / action
Respiratory compromise (severe curve/post-op)	Restrictive lung disease—monitor SpO₂/respiratory status; support.
Neurologic deficits (numbness, weakness, bowel/bladder)	Cord/nerve compression or post-fusion injury—urgent; notify provider.
Rib hump / uneven shoulders (Adams test)	Screens for scoliosis—refer for Cobb-angle evaluation.
Early ROM loss in an immobile patient	Contracture forming—intensify ROM/positioning/mobility.
Brace fit/skin integrity	Ensure effective bracing and prevent skin breakdown.

Red flags — notify / act now New neurologic deficits (numbness, weakness, changes in bowel/bladder function—possible cord compression), respiratory distress/hypoxia (severe curve or post-op), and post-spinal-fusion neurovascular deficits or excessive drainage. Notify the provider immediately.

Diagnostic Tests

Test	Purpose / why ordered	Findings, prep & nursing considerations
Adams forward-bend test	Screen for scoliosis	The patient bends forward at the waist; the nurse looks for a rib hump/asymmetry. Simple, noninvasive screening (school screenings).
Spinal X-ray (with Cobb angle)	Confirm/measure curvature	Cobb angle: >10° = scoliosis; roughly 25–45° → bracing; >45–50° → surgery. Assesses severity and progression.
MRI/CT	Evaluate cord/nerve involvement or surgical planning	Used for neurologic symptoms or complex curves.
Pulmonary function tests	Assess restrictive lung effects in severe curves	Detect reduced lung volumes.
Goniometry / ROM measurement	Quantify joint range (contractures)	Tracks ROM loss and response to therapy.

Patient teaching — screening & imaging Explain that the Adams forward-bend test is a painless screen and that an X-ray with the Cobb angle measures the curve and guides treatment (observation, bracing, or surgery). Emphasize that early detection during growth allows less invasive treatment.

Laboratory Tests

Lab	Normal range	Significance & trend
Calcium & vitamin D (kyphosis/osteoporosis)	Ca²⁺ 8.5–10.5 mg/dL; vit D adequate	Low levels contribute to osteoporotic kyphosis—supplement to support bone.
CBC (post-op)	Hgb ~12–17 g/dL	Monitor for blood loss after spinal fusion (major surgery); trend H&H.
Coagulation studies (peri-op)	INR ~1	Baseline for surgery/anticoagulation VTE prophylaxis.
WBC (post-op)	5,000–10,000/µL	Elevated → possible surgical-site infection.

Note: spinal disorders are diagnosed mainly by examination and imaging (Cobb angle), not labs. Labs mostly support osteoporosis (kyphosis) and post-operative monitoring after spinal fusion.

NCLEX pearl — imaging over labs For scoliosis/kyphosis, the key data are the physical exam (Adams test) and X-ray Cobb angle—not labs. Labs matter for osteoporosis-related kyphosis (calcium/vitamin D) and for post-fusion monitoring (H&H, WBC). Contractures are assessed by ROM, not labs.

Medications

Class / drug	Mechanism, use & key nursing/NCLEX points
Analgesics — acetaminophen, NSAIDs, opioids (post-op)	Manage back pain (kyphosis/scoliosis) and post-fusion pain. NSAID GI/renal caution; monitor opioids (sedation/respiratory, constipation)—especially after spinal surgery.
Osteoporosis therapy — bisphosphonates, calcium, vitamin D (kyphosis)	Treat the underlying osteoporosis causing kyphotic vertebral fractures. (See bone-disorders lesson for bisphosphonate administration.)
Muscle relaxants / antispasticity agents — baclofen, tizanidine (contractures/spasticity)	Reduce spasticity that contributes to contractures (e.g., in neuromuscular disease). Cause drowsiness—fall/sedation caution; don't stop baclofen abruptly.
Botulinum toxin injections (select spasticity)	Reduce focal spasticity to help ROM/positioning in some contracture cases.
VTE prophylaxis / antibiotics (post-op)	Prevent clots and surgical infection after spinal fusion.

Safety — spinal surgery & spasticity medications After spinal fusion, manage pain, monitor neurovascular and respiratory status, give VTE prophylaxis, and use log rolling to protect the spine. Baclofen for spasticity should not be stopped abruptly (withdrawal), and it causes sedation—fall precautions. There is no medication that "cures" the curve or reverses a contracture—prevention and mechanical treatment (bracing, therapy, surgery) are key. NCLEX testing points Scoliosis/kyphosis → analgesia; osteoporosis therapy (kyphosis); bracing/surgery are the main treatments. Contractures → prevention (ROM/positioning/mobility) ± antispasticity meds (baclofen). Post-fusion → pain control, log rolling, neurovascular/respiratory monitoring, VTE prophylaxis.

Nursing Interventions

Priority	Intervention & WHY
Breathing (severe curve / post-op)	Monitor respiratory status and SpO₂, encourage deep breathing/incentive spirometry—severe curves and spinal surgery reduce lung expansion; prevent atelectasis/pneumonia.
Neurovascular / spine protection (post-fusion)	Perform neurovascular checks, log roll to keep the spine aligned, and monitor the incision/drainage—protect the surgical repair and detect nerve injury early.
Contracture PREVENTION (top nursing priority)	Regular range-of-motion exercises, frequent repositioning, proper body alignment, splints/foot boards (prevent foot drop), and early mobility—keep joints moving so soft tissue doesn't shorten. Prevention is far easier than reversal.
Bracing (scoliosis)	Ensure the brace is worn as prescribed (often 16–23 hours/day) and fits well; protect skin; support adherence—bracing halts curve progression during growth only if worn.
Comfort & pain	Pain management, positioning, and support—improve function and adherence.
Safety	Fall prevention (altered balance/mobility), skin care (braces/immobility), and monitoring for complications.
Patient/family education	Brace compliance, exercise/posture, contracture-prevention techniques, and (adolescents) psychosocial/self-image support.
Interdisciplinary	Orthopedics, PT/OT (ROM/bracing/exercise/splinting), respiratory therapy, pain management, and (scoliosis) child-life/psychosocial support.

Why "move it or lose it" prevents contractures When a joint isn't moved, the muscles and tendons around it gradually shorten and stiffen until it's frozen in place. Once a contracture is fixed, it's extremely hard to reverse—so the nursing emphasis is prevention: range-of-motion exercises, correct positioning/alignment, splints (like a foot board to prevent foot drop), and getting the patient moving early. This is one of the most tested and most important nursing responsibilities for immobile patients.

Potential Complications

Complication	Early signs	Nursing response
Restrictive lung disease / respiratory compromise	Dyspnea, hypoxia, decreased lung volumes	Oxygen, deep breathing/spirometry, monitor SpO₂, notify provider; support ventilation if severe.
Neurologic injury / cord compression	Numbness, weakness, bowel/bladder changes	Urgent: notify provider, neuro checks, protect the spine; possible surgery.
Post-fusion complications (bleeding, infection, nerve injury)	Excessive drainage, fever, new deficits	Monitor incision/VS/H&H, log roll, notify provider.
Permanent contracture / disability	Progressive ROM loss, fixed joint	Intensify ROM/positioning/therapy; splints; sometimes surgery.
Pressure injuries (immobility/brace)	Skin redness/breakdown under a brace or bony areas	Skin care, repositioning, proper brace fit/padding.
Foot drop (immobility/nerve)	Inability to dorsiflex the foot	Foot board/splint, ROM, positioning—prevent it.

Patient Education

Disease process: explain whether the problem is a sideways spinal curve (scoliosis), a forward thoracic hump (kyphosis), or a joint stuck from immobility (contracture)—and how treatment helps. Scoliosis: wear the brace as prescribed (often 16–23 hours/day) during growth—it works only if worn; do prescribed exercises; care for the skin under the brace; and (for teens) address self-image concerns. After spinal fusion, use proper body mechanics, avoid twisting/heavy lifting/bending as directed, log roll, and report new numbness/weakness or wound problems. Kyphosis: practice good posture and back-strengthening exercises, and treat osteoporosis (calcium/vitamin D, weight-bearing exercise, bone medications). Contracture prevention (biggest teaching for immobile patients): perform range-of-motion exercises, reposition frequently, maintain proper alignment, and use splints/foot boards; get moving as soon as possible. Home care: continue therapy/exercises, use assistive devices, and prevent skin breakdown. Follow-up: orthopedics, PT/OT, and imaging to monitor curves. Warning signs / when to seek emergency care: new numbness, weakness, or bowel/bladder changes (cord compression), severe shortness of breath, or (post-op) worsening pain, fever, or wound drainage—seek care.

Clinical Judgment (NCSBN Model)

Recognize cues: a client recovering from a stroke has been on prolonged bed rest. The nurse notices the client's right elbow and knee are becoming difficult to straighten, with decreasing range of motion, and the foot tends to point downward (plantarflexed).
Analyze cues: immobility + decreasing ROM + joints fixing in flexion + a plantarflexed foot = developing contractures (and early foot drop)—soft tissue is shortening from lack of movement.
Prioritize hypotheses: prevent permanent contractures and foot drop—preserve function while the changes are still reversible.
Generate solutions: begin/intensify range-of-motion exercises (active/passive), reposition frequently, maintain proper alignment, apply splints and a foot board (prevent foot drop), and promote early mobility; manage spasticity/pain, involve PT/OT, and protect the skin.
Take action: ROM, positioning, splints/foot board, mobility, and therapy referral.
Evaluate outcomes: is ROM maintained/improving and are contractures/foot drop prevented? Reinforce ongoing ROM, positioning, and mobility with the client/family and care team to prevent recurrence.

Clinical Connections — commonly confused

	Scoliosis	Kyphosis	Contracture
Problem	Lateral (sideways) spinal curve (S/C)	Excessive forward thoracic curve (hump)	Joint frozen from immobility (soft-tissue shortening)
Key sign	Uneven shoulders/hips, rib hump (Adams test)	Rounded upper back, forward head, height loss	Loss of ROM, fixed flexed joint, foot drop
Cause	Idiopathic (teens), congenital, neuromuscular	Posture, Scheuermann's, osteoporosis	Immobility (stroke, bed rest, casting, spasticity)
Diagnostics	Adams test, X-ray Cobb angle	X-ray; osteoporosis workup	ROM/goniometry (exam)
Treatment	Observe → brace → spinal fusion	Posture/exercise, treat osteoporosis, ± brace	Prevention (ROM/positioning/mobility); splints, therapy
Priority nursing	Brace compliance; post-fusion care	Osteoporosis/posture; pain	Prevent contractures in immobile patients

Key confusion: scoliosis = sideways, kyphosis = forward hump, and both are spinal curves; a contracture is a joint problem from immobility, not a spinal curve. Also don't confuse kyphosis (forward) with lordosis (exaggerated inward lumbar/"swayback") curve.

NCLEX High-Yield Review

What the NCLEX Wants You to Know

Scoliosis = lateral curve; screen with Adams forward-bend test (rib hump); Cobb angle grades it
Bracing works only if worn (16–23 hr/day); braces halt progression during growth
Post-spinal fusion: log roll, neurovascular & respiratory checks, VTE prophylaxis
Kyphosis often = osteoporosis (dowager's hump)
Contractures are PREVENTED with ROM, positioning, and mobility

Frequently tested findings: scoliosis asymmetry/rib hump, kyphosis hump/osteoporosis, and contracture ROM loss/foot drop. Common distractors: thinking a brace corrects an existing curve (it halts progression), skipping ROM in immobile patients, forgetting log rolling after fusion, and confusing kyphosis with lordosis/scoliosis. Priority interventions: respiratory monitoring (severe curve/post-op), spine protection/neuro checks after fusion, and contracture prevention. Expected vs unexpected: mild curves/early ROM limits are managed; new neuro deficits or respiratory distress are emergencies. Patient teaching: brace compliance, posture/exercise, osteoporosis care, ROM/positioning, and post-op precautions. Safety: log rolling, neurovascular/respiratory monitoring, skin care under braces, fall/foot-drop prevention. Delegation: RN assesses, interprets, and provides post-op care; UAP can perform ROM (per plan), repositioning, apply a foot board/splint (per plan), assist with mobility, and take vitals and report—not assess/interpret. Frequently tested meds: analgesics, osteoporosis therapy, baclofen (don't stop abruptly). Critical labs: calcium/vitamin D (kyphosis), H&H/WBC (post-op). Most common mistakes: not preventing contractures, misusing bracing, and skipping log rolling.

Memory Aids

Scoliosis vs. kyphosis: "Scoliosis = Sideways (S-curve); Kyphosis = Kurved forward (hump)." (Lordosis = swayback inward.)
Scoliosis screen "bend and look for the hump": Adams forward-bend test → rib hump; X-ray Cobb angle measures severity.
Bracing "wear it to work": a brace halts progression only if worn as prescribed (~16–23 hr/day).
Post-fusion "Log roll & check the legs": log roll to protect the spine; neurovascular checks distal to the surgery.
Contractures "Move it or lose it": ROM, reposition, align, splint (foot board = no foot drop) — prevention is everything.
Kyphosis in older adults = "dowager's hump" = think osteoporosis.

Case Study — from admission to discharge

Admission. Emma, 13, is referred after a school screening showed uneven shoulders and a rib hump on forward bending. An X-ray reveals a right thoracic curve with a Cobb angle of 32°. She is still growing. The provider prescribes a thoracolumbosacral (Boston) brace.

Step 1–2: Recognize & analyze cues

Cues: positive Adams forward-bend test (rib hump), uneven shoulders, and a Cobb angle of 32° in a growing adolescent = adolescent idiopathic scoliosis of moderate severity (bracing range). Goal: halt progression during growth.

Step 3–4: Prioritize & plan

Priority: brace compliance and monitoring for progression, plus psychosocial support. Plan: teach wearing the brace as prescribed (~16–23 hr/day), proper fit and skin care, prescribed exercises, and regular follow-up X-rays; address self-image concerns.

Step 5: Take action

The nurse teaches Emma and her family about consistent brace wear (it only works if worn), skin protection, exercises, and follow-up, and provides emotional/peer support to encourage adherence.

Step 6: Evaluate & discharge

The curve is stable on follow-up. Discharge teaching: wear the brace as prescribed, inspect and protect the skin, continue exercises, keep orthopedic follow-up/imaging, and report worsening asymmetry or breathing problems; if the curve progresses (>45–50°), spinal fusion may be discussed (with log-rolling and neurovascular/respiratory post-op care).

NCLEX Practice Questions

1. A school nurse screens an adolescent for scoliosis. Which technique is used, and what is the nurse looking for?

Have the client stand on one leg and check for balance
Have the client bend forward at the waist and observe for a rib hump/asymmetry
Have the client extend the neck and check range of motion
Percuss the spine for tenderness

Rationale

Answer: 2. The Adams forward-bend test—bending forward at the waist while the nurse observes for a rib hump and asymmetry—screens for scoliosis. Balance testing (1), neck ROM (3), and spinal percussion (4) do not screen for scoliosis.

2. An adolescent with scoliosis is prescribed a brace. Which statement indicates correct understanding?

"The brace will straighten and cure the existing curve."
"I only need to wear it when my back hurts."
"I can stop wearing it once I feel better."
"I need to wear the brace as prescribed, often 16 to 23 hours a day, to keep the curve from getting worse while I grow."

Rationale

Answer: 4. Bracing halts curve progression during growth and works only if worn as prescribed (often 16–23 hr/day). It does not "cure"/straighten the curve (1), is not PRN (2), and must be worn consistently (3).

3. A client on prolonged bed rest is at risk for contractures. Which nursing intervention is most important to prevent them?

Perform range-of-motion exercises and reposition the client regularly
Keep the joints completely immobile
Elevate the head of the bed at all times
Restrict fluids to reduce swelling

Rationale

Answer: 1. Range-of-motion exercises and frequent repositioning keep joints moving so soft tissue doesn't shorten—preventing contractures. Immobilizing joints (2) causes contractures, and options 3 and 4 don't prevent them.

4. Which finding is characteristic of kyphosis?

A lateral (sideways) curvature of the spine
A joint fixed in a flexed position
An excessive rounding (forward hump) of the upper back
An exaggerated inward curve of the lower back

Rationale

Answer: 3. Kyphosis is an excessive forward (outward) curvature of the thoracic spine—a rounded upper-back "hump." A lateral curve (1) is scoliosis, a fixed flexed joint (2) is a contracture, and an exaggerated inward lumbar curve (4) is lordosis.

5. A client is 1 day post-op from spinal fusion for scoliosis. Which nursing action is correct?

Have the client sit straight up and twist to reposition
Encourage the client to bend at the waist to reach items
Avoid all repositioning to protect the spine
Log roll the client and perform neurovascular checks

Rationale

Answer: 4. After spinal fusion, log roll the client (keeping the spine aligned) and perform neurovascular checks. Twisting (1) and bending at the waist (2) endanger the repair, and avoiding all repositioning (3) risks pressure injuries/complications.

6. SATA. Which findings are consistent with scoliosis? Select all that apply.

Uneven shoulder heights
A rib hump on forward bending
Asymmetric waist and hip heights
An exaggerated inward curve of the lower back only
Clothes that fit unevenly

Rationale

Answers: 1, 2, 3, 5. Uneven shoulders, a rib hump, asymmetric waist/hips, and uneven clothing fit reflect scoliosis (lateral curve + rotation). An exaggerated inward lumbar curve alone (4) describes lordosis.

7. SATA. Which interventions help prevent contractures in an immobile client? Select all that apply.

Perform active and passive range-of-motion exercises
Reposition the client frequently and maintain proper alignment
Use a foot board or splints to prevent foot drop
Keep the affected limbs continuously flexed and still
Promote early mobility as soon as possible

Rationale

Answers: 1, 2, 3, 5. ROM exercises, frequent repositioning/alignment, foot boards/splints, and early mobility all prevent contractures. Keeping limbs continuously flexed and still (4) promotes contractures.

8. Priority. A nurse is caring for four clients. Which client should the nurse assess first?

An adolescent with scoliosis asking about brace care
A client post-spinal fusion who reports new numbness and weakness in the legs and cannot feel the nurse's touch
A client with kyphosis requesting posture-exercise teaching
A client with a mild contracture scheduled for PT

Rationale

Answer: 2. New numbness, weakness, and loss of sensation after spinal fusion suggest spinal cord/nerve injury or compression—a neurologic emergency and the priority. The others are stable/routine.

9. Delegation. Which task can the RN appropriately delegate to unlicensed assistive personnel (UAP)?

Performing passive range-of-motion exercises and repositioning per the established plan of care
Assessing neurovascular status after spinal fusion
Teaching brace compliance to an adolescent
Interpreting a client's Cobb angle

Rationale

Answer: 1. Performing ROM and repositioning within the established plan is within UAP scope and supports contracture prevention. Neurovascular assessment (2), teaching (3), and interpreting diagnostics (4) require the licensed nurse.

10. NGN Case Study. A 78-year-old woman with osteoporosis has developed a pronounced rounding of her upper back ("hump"), height loss, and mid-back pain. X-ray shows exaggerated thoracic curvature with vertebral compression changes. She reports some shortness of breath with exertion.

a) What is happening and which cues support it?
b) What are the priority nursing actions and key teaching?

Model answer

a) What's happening: kyphosis (dowager's hump) from osteoporosis. Supporting cues: pronounced forward thoracic curvature, height loss, back pain, and vertebral compression changes in a woman with osteoporosis; the exertional dyspnea reflects reduced lung expansion from the curve.

b) Priority actions/teaching: 1) treat the underlying osteoporosis (calcium/vitamin D, weight-bearing exercise, bone medications—correct bisphosphonate technique) to prevent further vertebral fractures. 2) Pain management, posture and back-strengthening exercises, and monitor respiratory status. 3) Fall prevention (altered balance/fragile bones) and safe mobility. Key teaching: osteoporosis medications/diet, posture/exercise, fall prevention, and report worsening breathing or new severe back pain. Evaluate: stable/improved posture and pain, no new fractures, and adequate respiratory function.

Key Takeaways

Scoliosis = lateral (sideways) spinal curve (S/C), often adolescent idiopathic; screen with the Adams forward-bend test (rib hump) and grade with the Cobb angle.
Bracing halts curve progression during growth—only if worn as prescribed (often 16–23 hr/day); it doesn't "cure"/straighten. Severe curves (>45–50°) → spinal fusion.
After spinal fusion: log roll, perform neurovascular and respiratory checks, give VTE prophylaxis, and monitor the incision.
Kyphosis = excessive forward thoracic curve ("hump"); in older adults it's often from osteoporosis—treat the bone disease and posture.
Contractures = joints frozen from immobility; they are PREVENTED with ROM exercises, frequent repositioning/alignment, splints/foot boards (prevent foot drop), and early mobility—"move it or lose it."
Severe spinal curves can cause restrictive lung disease—monitor breathing. Watch for new neurologic deficits (cord compression).
Diagnosis is mainly by exam and imaging (Cobb angle/ROM), not labs; labs support osteoporosis (kyphosis) and post-op care.

References

Hinkle, J. L., Cheever, K. H., & Overbaugh, K. J. (2022). Brunner & Suddarth's textbook of medical-surgical nursing (15th ed.). Wolters Kluwer/Lippincott.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.
Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2022). Wong's essentials of pediatric nursing (11th ed.). Elsevier.
Silvestri, L. A., & Silvestri, A. E. (2023). Saunders comprehensive review for the NCLEX-RN examination (9th ed.). Elsevier.
Assessment Technologies Institute. (2023). ATI RN adult medical-surgical & nursing care of children review modules (12th ed.). ATI Nursing Education.
Jarvis, C., & Eckhardt, A. (2024). Physical examination & health assessment (9th ed.). Elsevier.
Weinstein, S. L., Dolan, L. A., Cheng, J. C., Danielsson, A., & Morcuende, J. A. (2008). Adolescent idiopathic scoliosis. The Lancet, 371(9623), 1527–1537. https://doi.org/10.1016/S0140-6736(08)60658-3
Scoliosis Research Society. (2024). Scoliosis, kyphosis, and spinal deformity: Patient and professional resources. https://www.srs.org
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2024). Scoliosis, kyphosis, and joint contractures. U.S. National Institutes of Health. https://www.niams.nih.gov

Spinal Disorders

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Welcome & Getting Started

Launch RN Simulator

Wellness Center

Nursing Foundations

Fundamentals & Safety

Pharmacology

Dosage Calculations

Leadership, Management & Delegation

Medical-Surgical Body Systems

Neurological System

Sensory System

Endocrine System

Respiratory System

Cardiovascular System

Hematologic/Immune/Lymphatic System

Gastrointestinal (GI) System

Renal & Genitourinary

Reproductive System

Musculoskeletal System

Integumentary System

Specialty Areas

Maternity

Infectious Diseases

Pediatrics

Mental Health

NCLEX Success Center

Clinical Judgment Practice

Prioritization Practice

Delegation Practice

Lab Values

Final Review